About PRISTIQ

By Alicia Doyle
HighYa Staff Published on: Sep 24, 2018

An estimated 16.2 million adults in the United States have had at least one major depressive episode, making it one of the most common mental disorders in America, according to the National Institute of Mental Health.

Fortunately, a dual-action antidepressant called PRISTIQ might be tremendously helpful for the right candidates.

This article takes a comprehensive look at PRISTIQ, including what it is and how it works, safety factors, scientific studies, and other important factors you should keep in mind if you’re considering taking this prescription drug.

We’ve obtained input from two Medical Doctors on this topic, as well as information from the U.S. Food and Drug Administration and other sources, to provide you with as much information as possible so you can decide if PRISTIQ is right for you.

Keep in mind that this article is not intended as medical advice, so it’s important that you talk to your medical provider before taking PRISTIQ.

Signs and Symptoms of Depression

Every 20 minutes, somebody kills themselves in the United States, and more often than not, people go through life with depression undiagnosed, said Dr. Lukas Alexanian, Medical Director of the psychiatry department and Chief of Staff Elect at Adventist Health Glendale in Southern California.

Depression itself generally tends to be a chronic, life-long condition, and is two times more common for females than males, he said, and the symptoms typically include the following:

  • Overall sad mood
  • Severe anxiety
  • Low energy
  • Poor motivation
  • Hopelessness
  • Insomnia
  • Irritability
  • Suicidal ideations

“If you have five of these symptoms for one to two weeks you qualify for depression,” Dr. Alexanian said.

However, being sad or having other stressors that make you upset doesn’t necessarily automatically mean you have depression, he noted.

“It means you need to be evaluated and see if you meet the criteria because you could have another condition,” Dr. Alexanian advised.

For instance, an adjustment disorder for depressed mood isn’t necessarily treated with medication.

“We help them adjust through therapy and psychotherapy,” Dr. Alexanian said. “It’s not a chemical imbalance or clinical depression. You could have it because you’re having a hard time adjusting to a situation.”

He re-emphasized the importance of seeing a specialist before taking any kind of antidepressant.

“You need to see a specialist who is trained to recognize and diagnose depression based on the longevity of symptoms and the number of symptoms,” Dr. Alexanian recommended.

According to a medication guide approved by the U.S. Food and Drug Administration, call your healthcare provider if you have any of the following symptoms, especially if they are new, worse, or worry you:

  • Thoughts about suicide or dying
  • Trouble sleeping (insomnia)
  • Attempts to commit suicide
  • New or worse irritability
  • New or worse depression
  • Acting aggressive, being angry, or violent
  • New or worse anxiety
  • Acting on dangerous impulses
  • Feeling very agitated or restless
  • An extreme increase in activity and talking (mania)
  • Panic attacks
  • Other unusual changes in behavior or mood

Fortunately, an antidepressant called PRISTIQ might be helpful for people with depression, which we cover next.

PRISTIQ: What It Is and How It Works

Approved for use as an antidepressant in 2008, PRISTIQ targets two neurotransmitters in the brain, and works by blocking the re-uptake of two neurotransmitters: serotonin and norepinephrine, said Dr. Anandhi Narasimhan, a child and adult psychiatrist at Anandhi Narasimhan M.D. in Los Angeles, California.

“By doing this, the neurotransmitters are more abundant and they are noted to improve mood,” explained Dr. Narasimhan, who also works as a staff psychiatrist at two non-profit organizations, Aviva Family and Children's Services and Masada Homes.

PRISTIQ is what is known as a “dual-action” antidepressant, Dr. Alexanian further explained.

“It fixes two chemicals involved with depression – one is serotonin, the other is norepinephrine,” he said.

Serotonin, which is primarily found in the GI tract, blood platelets and the central nervous system, is believed to be a contributor to feelings of well-being and happiness. Norepinephrine is an organic chemical that functions in the brain and body as a hormone and neurotransmitter.

“PRISTIQ increases both serotonin and norepinephrine in people’s brains,” Dr. Alexanian said. “And it’s important to understand that PRISTIQ doesn’t artificially add norepinephrine, it helps your own norepinephrine to be increased in your system.”

Is PRISTIQ Safe?

There are several factors to be considered with respect to safety, Dr. Narasimhan said.

If an individual is taking other medications, there can be drug interactions, “so that should be noted and monitored,” he advised.

However, PRISTIQ can have lower drug interactions compared to other antidepressants because of its mechanism of metabolism, which may make it beneficial.

“It can have more prominent side effects such as hyponatremia (low sodium) in the elderly,” Dr. Narasimhan noted.

It is important to start at a low dose and gradually increase a dose, he emphasized.

“It can precipitate mania symptoms in individuals with bipolar disorder,” Dr. Narasimhan warned. “As with most medications, it is important to discuss your health profile with your doctor before taking antidepressants.”

According to Dr. Alexanian, PRISTIQ is safe.

“There is no major long-term organ system damage, and can be done safely under a doctor’s supervision for many years,” he said.

Scientific Studies of PRISTIQ

Dr. Narasimhan noted that according to research, PRISTIQ can improve symptoms of major depressive disorder when compared to placebo.

“It is generally well tolerated according to the research,” said Dr. Narasimhan, who noted the following scientific studies about PRISTIQ, which is also known as desvenlafaxine.

On study is entitled: “A Randomized, Double-Blind, Placebo-Controlled Trial of Desvenlafaxine Succinate in Adult Outpatients With Major Depressive Disorder.”

The study indicated that major depressive disorder “is a serious illness,” with an estimated 16% lifetime prevalence in the United States.

This study evaluated the efficacy and tolerability of desvenlafaxine succinate (desvenlafaxine) in the treatment of major depressive disorder. In this 8-week trial, adult outpatients (aged 18 - 75 years) with a primary diagnosis of major depressive disorder were randomly assigned to treatment with desvenlafaxine (100–200 mg/day) or placebo.

The conclusion of the study noted that desvenlafaxine was generally safe and well tolerated. In this study, it did not show significantly greater efficacy than placebo on the primary or key secondary efficacy end-points, but it did demonstrate efficacy on an alternate depression scale and pain measure associated with major depressive disorder.

Another study is entitled: “Efficacy, safety, and tolerability of desvenlafaxine 50 mg/day and 100 mg/day in outpatients with major depressive disorder.”

The objective was to assess the efficacy, safety, and tolerability of 50- and 100-mg/day doses of desvenlafaxine (administered as desvenlafaxine succinate), a serotonin-norepinephrine reuptake inhibitor, for the treatment of major depressive disorder.

The intent-to-treat population included 447 patients. The 100-mg dose group experienced significant improvements compared with placebo on several secondary efficacy measures, including the 6-item Hamilton Depression Rating Scale and the Visual Analog Scale–Pain Intensity total score.

Both desvenlafaxine doses were generally well-tolerated, with the most common adverse events including dry mouth, constipation, insomnia, decreased appetite, hyperhidrosis, and dizziness.

The study noted that the results demonstrate efficacy, safety, and tolerability of desvenlafaxine 50 mg/day for treating major depressive disorder.

According to a medication guide approved by the U.S. Food and Drug Administration, the exact mechanism of the antidepressant action of desvenlafaxine is unknown; but is thought to be related to the potentiation of serotonin and norepinephrine in the central nervous system, through inhibition of their reuptake. The guide also noted that non-clinical studies have shown that desvenlafaxine is a potent and selective serotonin and norepinephrine reuptake inhibitor.

How Does PRISTIQ Compare to Other Antidepressants?

As far as a comparison to other antidepressants is concerned, “we don’t have what we call a head-to-head study with other antidepressants, so we don’t know if they’re better or worse,” Dr. Alexanian said.

“But because of the fact that they have an extra effect, they tend to be able to treat a larger population of those with depression,” he noted. However, “to determine if they’re more effective or not, we need to do studies.”

Antidepressants differ on which neurotransmitters they target, Dr. Narasimhan noted.

“For example, the serotonin reuptake inhibitors block the reuptake of serotonin which allows more serotonin to be available to improve mood,” Dr. Narasimhan explained. “PRISTIQ targets serotonin and norepinephrine.”

When asked if PRISTIQ is considered better than other antidepressants, Dr. Narasimhan said that different people respond differently to different antidepressants.

“It depends on how the drug is metabolized and how the body interacts with the drug,” he noted. “So the answer is that it depends.”

According to Dr. Alexanian, PRISTIQ is a “quite effective” antidepressant, with success rates ranging from 55% to 60%, “which is pretty high in a medicine in general.”

“We believe that in depressed patients, serotonin and norepinephrine are not being produced enough,” he said. “Therefore, their mood gets dysregulated and PRISTIQ regulates the chemical back to normal.”

antidepressants like Zoloft and Prozac are serotonin inhibitors only – they don’t change norepinephrine like PRISTIQ does, “which makes it have an edge for other antidepressants,” Dr. Alexanian explained. “But it’s not unique because there are medications like PRISTIQ with serotonin and norepinephrine reuptake inhibitors, like Cymbalta.”

How Long Does It Take for PRISTIQ to Work?

Antidepressants such as PRISTIQ usually take at least a few weeks for people to begin to notice an improvement in symptoms, “sometimes longer and the dose may need to be adjusted,” Dr. Narasimhan said.

Dr. Alexanian noted that the FDA’s recommendation is to take the medication for 7 to 9 months, then taper down under supervision gradually, “because if you do it too fast, it can cause withdrawal.”

The brain needs a chance to pick up the pace and balance.

“You need to do it at the right time, not a stressful time,” Dr. Alexanian advised. “The recommendation for the first bout of depression is 7 to 9 months, then gradually decrease; there’s a 50% chance of depression not coming back.”

If it does come back, “you get the patient on the medication for at least a year…and the chances of it not coming back on the second go-around is only 25%,” Dr. Alexanian explained. “The third time around, you tell the patient that they need to be on medication their whole life.”

Ideal Candidates for PRISTIQ

Any person suffering from depression would be ideal, unless they have hypertension issues, Dr. Alexanian said.

“Also, PRISTIQ is not FDA-approved for children,” he said.

Additionally, PRISTIQ is not approved for use in pediatric patients, according to a medication guide approved by the U.S. Food and Drug Administration.

PRISTIQ has been approved for the treatment of major depressive disorder, Dr. Narasimhan noted, “and may be considered as a second line agent for individuals whose depressive symptoms do not respond to serotonin reuptake inhibitors.”

According to the manufacturer’s website, do not take PRISTIQ if you are allergic to desvenlafaxine, venlafaxine, or any of the ingredients in PRISTIQ; or, if you currently take, or have taken within the last 14 days, a monoamine oxidase inhibitor, including intravenous methylene blue or the antibiotic linezolid.

Who Should Avoid PRISTIQ

Any antidepressant that increases your norepinephrine will increase your blood pressure, “so patients that have high blood pressure…should not be on PRISTIQ because their blood pressure could be sky high,” warned Dr. Alexanian, adding that some people might experience an allergic reaction.

For people suffering from manic depression and Bipolar Disorder, “you don’t ever want to give an antidepressant without a stabilizer, because that could make them more manic,” he said.

That’s why making the right diagnosis is crucial, Dr. Alexanian re-emphasized.

“Because they can be taking medication for no reason, or in the wrong way, or they might have other mental conditions where an antidepressant might be more beneficial or might do more harm,” he said. For instance, for people with bipolar manic depression, “it could make them worse unless we put them on a mood stabilizer.”

A person who does not show depressive symptoms doesn't require treatment with an antidepressant, Dr. Narasimhan added.

“A person with the diagnosis of bipolar disorder may have better improvement of symptoms with a mood stabilizer as opposed to an antidepressant,” he said.

Potential Side Effects of Taking PRISTIQ

Dr. Narasimhan said that some side effects of taking PRISTIQ may include nausea, vomiting, diarrhea, insomnia, anxiety, fatigue, dry mouth, dizziness, urinary hesitation, and/or suicidal thoughts.

The manufacturer’s website noted that in clinical studies, the most common side effects with PRISTIQ 50mg include: nausea, dizziness, sweating, constipation and decreased appetite.

As far as sex drive is concerned, the manufacturer noted that clinical studies show there was a low rate of sexual side effects in men and women taking 50 mg, similar to those who took a placebo. Sexual side effects include decreased sex drive, as well as delayed orgasm and ejaculation, and these side effects may increase with higher doses.

According to a medication guide approved by the U.S. Food and Drug Administration, all patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of increased or decreased dose changes.

Final Thoughts

Exercise and a healthy diet are important to our mood and well-being, Dr. Narasimhan said.

“Sometimes therapy, such as cognitive behavioral therapy and mindfulness exercises can improve mood,” noted Dr. Narasimhan, adding that micronutrient deficiencies in the diet can also contribute to how we are feeling.

“It is useful to get routine blood work, to make sure there aren't treatable causes of depression,” he advised. “Medical conditions, such as anemia and problems with the thyroid gland functioning, can affect mood, so those things should be looked at.”

Additionally, “it can be useful to monitor one's mood and other symptoms for a period of time before and after starting an antidepressant,” Dr. Narasimhan advised.

One of the most important factors is to make sure you are appropriately diagnosed, “and make sure you’re under the supervision of a doctor, hopefully, a psychiatrist,” Dr. Alexanian said.

Depression is a very prominent condition in our society, he further emphasized.

“Some of the symptoms are the second most common cause of disability,” Dr. Alexanian noted. “And it is important to recognize initial signs and symptoms and get appropriate care with a professional. And if you treat it early and aggressively, the chance of it not coming back is higher. You want to always consult with your doctor before taking an antidepressant.”

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